Comprehensive tabletop exercises identify FSM's strengths and weaknesses
FSM's tabletop exercises included agencies playing out their real-life roles. Photos courtesy of FSM Information Service
Palikir, Pohnpei— The Federated States of Micronesia has conducted a series of exercises to assess and simulate Pohnpei’s capacity and procedures for what to do when FSM nation’s citizens stranded abroad are allowed to be repatriated.
Although the FSM government has yet to set the date for opening its state borders, the national and state task forces are working the week of June 22 to assess the possibility of reopening Pohnpei on June 27. The exercises, held in Pohnpei from June 17 to 19, will also be conducted in Yap, Chuuk, Kosrae.
FSM, which closed all its state borders at the onset of coronavirus contagion, remains Covid-19 free. The nation also remains under a state of public health emergency. A number of FSM citizens are stranded in Hawaii and Guam, which both have Covid-19 cases.
The tabletop exercises included a simulation of how the national and state governments would respond if a commercial air carrier arrived in Pohnpei with FSM returning citizen, with at least one of the individuals beginning to show symptoms consistent with Covid-19 during the flight.
The exercises included agencies playing out their real-life roles, with a school bus acting as a commercial flight, and port, immigration, customs, quarantine, and health officials responding as if the bus’s passengers were citizens coming from a Covid-19 affected jurisdiction.
The scenario included a number of potential real-life encounters, such as how to effectively address an individual showing symptoms of Covid-19 whilst on the flight, how to receive and home-quarantine members of the diplomatic corps, and how to brief passengers at Pohnpei’s designated quarantine facility, which is China Star Hotel), on what will happen over their 14 days of quarantine.
Staff from the U.S. Embassy who posed as incoming diplomatic corps personnel advised that their experience was “really well organized; people were telling me where to go, gave me a mask—but one thing that I think we need to address is regarding the medical certificates. I am not 100 percent sure if I needed to bring it with me, or have it on me, or where or who to give it to—but overall, it we had good experience.”
The simulation for the diplomatic corps staff included getting off the flight, participating in the mandatory health screening, and how to properly enter their vehicle for immediate transport to their home-quarantine site.
While all incoming members of the diplomatic corps will be quarantined, due to the Vienna Convention they will be home-quarantined in a manner approximately equivalent to the home-quarantine for FSM President David W. Panuelo, and the home-quarantine for U.S. Ambassador Carmen G. Cantor.
The bulk of the passengers, save for the individual with potential Covid-19 symptoms, went through the mandatory health screening, followed by immigration, customs and quarantine.
One of the passengers, who was keen to speak but on the condition of anonymity, said: “It builds my confidence to work this out, but the problem areas need to be addressed before I think we’ll be comfortable with people coming home. I know you said you’ll mention this in your press release, but please emphasize that we need a standard operating procedure for general cleaning—the airport cleaners didn’t wear PPE (personal protection equipment) and were not trained for it.
The passenger said the immigration and custom officers "were not trained for properly donning and doffing. This can all be fixed, but it must be said so that our citizens know that we are really working on doing this right. When people come home, it’s the real scenario.”
Following the exercises, the national and state teams described the strengths and weaknesses for the point of entry, quarantine and isolation areas in an in-depth debriefing.
For point of entry’s strengths, it was noted that some of these included the presence of standard operating procedures (including protocols for different types of travelers and communications between crew and health authorities); effective role-sharing between crew, health, airport, fire, and rescue personnel, and infection control specialists; and environmental disinfection conducted by specialists from the Environmental Protection Agency and health teams. Visible markings were in place to identify appropriate locations to ensure physical distancing.
For weaknesses, it was noted that some of these included a lack of a “general cleaning” standard operating procedure, and that airport cleaners, immigration, and custom officers were either not wearing PPE and/or were untrained for their use. It was advised that there was a lack of proper disposal guidance and trash bins for used PPE, there was a lengthy waiting period for passport clearances, and no briefing was given to passengers on how they and their bags would be transported to the quarantine facilities.
For the quarantine site’s strengths, it was noted that some of these included that the management team was able to manage a distressed individual very well and otherwise adapt on the go, that registration and overall preparation were organized, the briefing to passengers on their stay was clear and helpful, and there were highly visible signs providing information and contact numbers for assistance.
For the weaknesses, it was noted that some of these included the need to conduct additional health-screening measures beyond a temperature check, that phones and wi-fi are presently disabled, that corridor security cameras are presently inaccessible, and that standard operating procedures for waste management and disposal, as well as an emergency evacuation plan (e.g. what to do if there’s a fire or typhoon) must be developed. Further, it was advised that the briefing given to passengers could be improved if it were standardized (such as with a set of talking points) and made more concise.
For the isolation area’s strengths, it was noted that some of these included that a call center/hotline has been established and manned by staff who follow standardized procedures; that staff donned their PPE in time before the arrival of the potential Covid-19 patient; the clinical assessment of the potential Covid-19 patient proceeded on time, with decontamination of the ambulance and equipment initiated. PPE doffing occurred in the appropriate area, and hand hygiene signs, posters, and handwashing items were in place.
For weaknesses, it was noted that some of these included that the ambulance only had a driver and doctor (the procedure calls for two medical personnel, not one); that although decontamination of the ambulance stretcher occurred it was not necessarily done properly; that no specimen collection kit was placed in the ante-room prior to the patient’s arrival; that one staff member doffed their PPE in the wrong order; and that the sharps container was both placed near other waste bins, risking misplacement of sharps, and made of cardboard and thus susceptible to disintegration. (Sharps refers to any medical instrument that is sharp or pointy—syringes, scalpels, etc.—and typically these items should be divorced from other types of waste).